Simulated Patient Interactions Research Articles

Perspectives of Nursing Students on Hybrid Simulation-Based Learning Clinical Experience: A Text-Mining Analysis.

Given the past limitations on clinical practice training during the COVID-19 pandemic, a hybrid format program was developed, combining a time-lapse unfolding case study and high-fidelity simulation. This study assesses the effectiveness of a new form of clinical training from the perspective of student nurses. A questionnaire was administered to 159 second-year nursing students enrolled in the "Basic Nursing Practice II" course. Text mining was performed using quantitative text analysis for the following items: (1) aspects that were learned more deeply, (2) benefits, and (3) difficulties encountered with the new practice format. The new clinical practice format enhanced participants' learning related to the daily changes required in nursing care and improved their nursing competency through simulated patient interactions. However, the participants faced difficulties dealing with patients accompanied by secular changes. Moreover, they found remote group work challenging. These findings can be applied to the development of new educational strategies.

Leveraging Space-Flown Technologies to Deliver Healthcare with Holographic Physical Examinations.

INTRODUCTION: Musculoskeletal injuries are one of the more common injuries in spaceflight. Physical assessment of an injury is essential for diagnosis and treatment. Unfortunately, when musculoskeletal injuries occur in space, the flight surgeon is limited to two-dimensional videoconferencing and, potentially, observations made by the crew medical officer. To address these limitations, we investigated the feasibility of performing physical examinations on a three-dimensional augmented reality projection using a mixed-reality headset, specifically evaluating a standard shoulder examination.METHODS: A simulated patient interaction was set up between Western University in London, Ontario, Canada, and Huntsville, AL, United States. The exam was performed by a medical student, and a healthy adult man volunteered to enable the physical exam.RESULTS: All parts of the standard shoulder physical examination according to the Bates Guide to the Physical Exam were performed with holoportation. Adaptation was required for the palpation and some special tests.DISCUSSION: All parts of the physical exam were able to be completed. The true to anatomical size of the holograms permitted improved inspection of the anatomy compared to traditional videoconferencing. Palpation was completed by instructing the patient to palpate themselves and comment on relevant findings asked by the examiner. Range of motion and special tests for specific pathologies were also able to be completed with some modifications due to the examiner not being present to provide resistance. Future work should aim to improve the graphics, physician communication, and haptic feedback during holoportation.Levschuk A, Whittal J, Trejos AL, Sirek A. Leveraging space-flown technologies to deliver healthcare with holographic physical examinations. Aerosp Med Hum Perform. 2024; 95(4):214-218.

A Generative Pretrained Transformer (GPT)-Powered Chatbot as a Simulated Patient to Practice History Taking: Prospective, Mixed Methods Study.

Communication is a core competency of medical professionals and of utmost importance for patient safety. Although medical curricula emphasize communication training, traditional formats, such as real or simulated patient interactions, can present psychological stress and are limited in repetition. The recent emergence of large language models (LLMs), such as generative pretrained transformer (GPT), offers an opportunity to overcome these restrictions. The aim of this study was to explore the feasibility of a GPT-driven chatbot to practice history taking, one of the core competencies of communication. We developed an interactive chatbot interface using GPT-3.5 and a specific prompt including a chatbot-optimized illness script and a behavioral component. Following a mixed methods approach, we invited medical students to voluntarily practice history taking. To determine whether GPT provides suitable answers as a simulated patient, the conversations were recorded and analyzed using quantitative and qualitative approaches. We analyzed the extent to which the questions and answers aligned with the provided script, as well as the medical plausibility of the answers. Finally, the students filled out the Chatbot Usability Questionnaire (CUQ). A total of 28 students practiced with our chatbot (mean age 23.4, SD 2.9 years). We recorded a total of 826 question-answer pairs (QAPs), with a median of 27.5 QAPs per conversation and 94.7% (n=782) pertaining to history taking. When questions were explicitly covered by the script (n=502, 60.3%), the GPT-provided answers were mostly based on explicit script information (n=471, 94.4%). For questions not covered by the script (n=195, 23.4%), the GPT answers used 56.4% (n=110) fictitious information. Regarding plausibility, 842 (97.9%) of 860 QAPs were rated as plausible. Of the 14 (2.1%) implausible answers, GPT provided answers rated as socially desirable, leaving role identity, ignoring script information, illogical reasoning, and calculation error. Despite these results, the CUQ revealed an overall positive user experience (77/100 points). Our data showed that LLMs, such as GPT, can provide a simulated patient experience and yield a good user experience and a majority of plausible answers. Our analysis revealed that GPT-provided answers use either explicit script information or are based on available information, which can be understood as abductive reasoning. Although rare, the GPT-based chatbot provides implausible information in some instances, with the major tendency being socially desirable instead of medically plausible information.

An Empathy and Arts Curriculum During a Pediatrics Clerkship: Impact on Student Empathy and Behavior.

Empathy is critical within medicine and improves patient outcomes and satisfaction. Empathy declines during the clerkship years due to the hidden curriculum, where students observe emotional distancing and desensitization by providers. Studies show arts curricula can preserve empathy but are limited by sample bias and preclerkship occurrence. We implemented and evaluated a brief pediatric clerkship arts curriculum to improve empathic behaviors. We created two 1-hour required small-group sessions for pediatric clerkship medical students. The first session paired arts observation techniques with various paintings. The students then applied these techniques to video-based simulated patient interactions in the second session. We used the Toronto Empathy Questionnaire (TEQ) and an empathy behavior checklist (EBC) as pre/post assessments to gauge self-reported empathy and empathetic behaviors. We compared responses of learners who attended the sessions (curriculum group) to learners unable to attend (control group). Thirty-four students participated in the curriculum; 19 were in the control group. Neither the control nor the curriculum group had a significant change in pre/post TEQ scores. Students with pre-TEQ scores less than 45 who participated in the curriculum had significant improvement in post-TEQ scores compared to their control group counterparts (p = .02). On the EBC, there was a significant difference between the curriculum and control groups for those who explored more about the child/family's experience (p < .05). Our work suggests that a brief clerkship arts curriculum is useful for improving self-reported empathy ratings and empathetic skills, particularly for students identified as having below-average empathy.

A holistic approach to remote patient monitoring, fueled by ChatGPT and Metaverse technology: The future of nursing education

ChatGPT and Metaverse are contemporary artificial intelligence tools that are increasingly being used in healthcare professional training, particularly for remote patient monitoring. These technologies offer immersive and personalized learning experiences for nurses, improving their skills and confidence in managing remote patient care. ChatGPT can create simulated patient interactions that mimic real-life scenarios, while the Metaverse can provide virtual reality simulations and scenarios for nurses to practice and learn in a safe and controlled environment. The unification of ChatGPT and Metaverse technology in nursing education can enrich the learning experience and equip nurses with the necessary skills for remote patient monitoring, ultimately leading to improved patient outcomes and quality of care.

Introductory patient communication training for medical physics graduate students: Pilot experience.

Despite medical physics becoming a more patient‐facing part of the radiation oncology team, medical physics graduate students have no training in patient communication. An introductory patient communication training for medical physics graduate students is presented here. This training exposes participants to foundational concepts and effective communication skills through a lecture and it allows them to apply these concepts through realistic simulated patient interactions. The training was conducted virtually, and eight students participated. The impact of the training was evaluated based on changes in both confidence and competence of the participants’ patient communication skills. Participants were asked to fill out a survey to assess their confidence on communicating with patients before and after the training. They also underwent a simulated patient interaction pre‐ and postlecture. Their performance during these was evaluated by both the simulated patient actors and the participants themselves using a rubric. Each data set was paired and analyzed for significance using a Wilcoxon rank‐sum test with an alpha of 0.05. Participants reported significantly higher confidence in their feeling of preparedness to interact with patients (mean = 2.38 vs. 3.88, p = 0.008), comfort interacting independently (mean = 2.00 vs. 4.00, p = 0.002), comfort showing patients they are actively listening (mean = 3.50 vs. 4.50, p = 0.005), and confidence handling challenging patient interactions (mean = 1.88 vs. 3.38, p = 0.01), after the training. Their encounter scores, as evaluated by the simulated patient actors, significantly increased (mean = 77% vs. 91%, p = 0.022). Self‐evaluation scores increased, but not significantly (mean = 62% vs. 68%, p = 0.184). The difference between the simulated patient and self‐evaluation scores for the postinstruction encounter was statistically significant (p = 0.0014). This patient communication training for medical physics graduate students is effective at increasing both the confidence and the competence of the participants in the subject. We propose that similar trainings be incorporated into medical physics graduate training programs prior to students entering into residency.

Evaluation of undergraduate students’ nursing assessment and communication skills through an objective structured clinical examination within a high-fidelity simulation using a student-simulated patient†

Abstract Objective To evaluate nursing students’ assessment and communication skills through an objective structured clinical examination (OSCE) within a high-fidelity simulation using a student-simulated patient (SSP) and analyze the validity, reliability, degree of difficulty, and discriminability of the OSCE. Methods A descriptive study was conducted at one nursing school in Macao. All scenarios were designed using a high-fidelity simulator combined with SSPs. A convenience sample of 54 baccalaureate nursing students completed the OSCE. The nursing assessment OSCE checklist (NAOC) and the communication evaluation rubric (CER) were used as observational measurements with three-point Likert scales (2 = Achieved, 1 = Partly achieved, 0 = Not completed/Incorrect). Results Difficulty coefficients of the exam were 0.63 for nursing assessment skills and 0.56 for communication skills. The discrimination index of the majority items of the NAOC (86.4%) was &gt;0.20, showing a better to good discriminability. The items of the CER had satisfactory indexes of item discrimination (from 0.38 to 0.84). Students received high scores in conducting blood oxygen saturation and cardiac and lung auscultation but low scores in vomiting and diarrhea assessment. Students presented good communication skills in eye contacting and listening, but culture assessment needs to be improved. The students with experiences in simulation or simulated patient (SP) interactions had better assessment and communication skills than students without those experiences. There was a positive relationship between nursing assessment and communication skills (r = 0.67, P = 0.000). Conclusions SSPs were involved in enhancing the realism of interactions in simulated scenarios. Nursing students can conduct nursing assessments specific to patient conditions, explain the conditions to the patient, and ensure that the patient remains informed at all times of the precautions to be taken. However, students’ cultural awareness and some communication skills need further training. With moderate difficulty and high discrimination index, OSCE showed satisfactory reliability and validity.

Educational Methods and Technological Innovations for Introductory Experiential Learning Given the Contact-Related Limitations Imposed by the SARS-CoV2/COVID-19 Pandemic.

Background: Acute respiratory syndrome related coronavirus disease (COVID-19) has led to substantial changes in pharmacy curricula, including the ability to provide in-person introductory experiential practice experiences (IPPEs) to University of Colorado’s International-Trained PharmD (ITPD) students. Methods: The IPPE course for ITPD students was redesigned to offer remote educational activities in the health system setting and simulated practice and communication activities in the community setting. Students were evaluated via surveys regarding the perceived value of these changes, and changes in knowledge, skills and abilities before and after activities. Results: A total of 6 students were enrolled in the revised IPPE course. Students agreed or strongly agreed that the overall distance-based IPPE experience, the remote health system activities, and the community activities were valuable. Students also strongly agreed that course design successfully met course outcomes and was relevant to pharmacy practice. In terms of knowledge, skills and abilities, numeric improvements were observed in remote health system activities and community-based simulated patient interactions, but results were not statistically significant. A high baseline level of knowledge led to minimal improvements in perceptions of improvement in community pharmacy skills regarding pharmacy simulation software. Conclusion: Implementation of distance-based IPPE activities may be an alternate educational modality.

Introduction of a psychologically informed educational intervention for pre-licensure physical therapists in a classroom setting

BackgroundThere is an increasing need for physical therapists to address psychosocial aspects of musculoskeletal pain. Psychologically informed practice is one way to deliver this type of care through the integration of biopsychosocial interventions into patient management. An important component of psychologically informed practice is patient centered communication. However, there is little research on how to effectively implement patient centered communication into pre-licensure training for physical therapists.MethodsThirty Doctor of Physical Therapy (DPT) students took part in an educational intervention that consisted of one 4-h didactic teaching session and three 1-h experiential learning sessions. Prior to the first session, students performed an examination of a standardized patient with chronic low back pain and were assessed on psychologically informed physical therapy (PIPT) adherent behaviors via a rating scale. Students also completed the Pain Attitudes and Beliefs Scale (PABS-PT). After the last experiential session, students evaluated another standardized patient and were reassessed on PIPT adherent behaviors. Students retook the PABS-PT and qualitative data was also collected.ResultsAfter the educational intervention, students had positive changes in their pain attitudes and belief scores indicating a stronger orientation toward a psychosocial approach to patient care (p < 0.05). Additionally, after the intervention, students showed improvements in their adherence to using PIPT behaviors in their simulated patient interactions (p < 0.05). Qualitatively, students reported a high acceptability of the educational intervention with common themes indicating improved confidence with treating and communicating with complex patients.ConclusionStudents had attitudes and beliefs shift towards a more psychosocial orientation and demonstrated improved PIPT behaviors in simulated patient interactions after a brief educational intervention. Future research should investigate best practices for implementation of psychologically informed physical therapy for licensed clinicians.

Teaching Patient-Related Communication to Surgical Residents in Brief Training Sessions

Effective provider-patient communication has several benefits; however, few surgical residency programs have communication training and surgical residents have limited time for education. We developed a communication curriculum with limited didactics and emphasis on practice. Our objective was to evaluate whether this time-limited intervention led to changes in surgical resident communication skills. A 4-module curriculum was implemented for surgical residents (PGY2-4). Each 30-minute module focused on specific communication micro-skills: empathy, concerns and expectations, chunking information and avoiding jargon, and teach-back. Modules included brief didactics, simulated patient interactions, feedback, and debriefing. Precurriculum, residents completed a 2-station objective structured clinical examination (OSCE) and a survey on communication confidence. Residents evaluated each module and postcurriculum, completed another 2-station OSCE, confidence survey, and overall curriculum evaluation. Using validated rating scales, OSCEs were scored by 2 independent raters. Tertiary care, academic center with a 5-year surgical residency program. All 17 eligible residents completed both OSCEs and surveys, and 14 attended ≥3 modules. Following the curriculum, residents reported increased use of the targeted skills and increased confidence in responding to emotions, information sharing, and bad news telling (p < 0.004). There was no change in history taking. Residents rated the usefulness of each module modestly (2.5-3.1, scale 0-4), however, the likelihood of skill implementation was higher (3.2-3.6). The overall postcurriculum OSCE scores increased (versus precurriculum scores, p < 0.001). Postcurriculum scores increased for empathy, concerns and expectations, and teach-back. Chunking information and avoiding jargon was unchanged. Fifteen residents reported module length as appropriate, and 2 thought they were too short. The brief modules led to increased self-reported use of communication skills and were effective in improving resident communication in OSCEs. This may be a useful curricular model for both surgical and nonsurgical residency programs with limited availability for curricular time.

Pharmacists’ perceptions of the pharmacists’ patient care process and performance in a simulated patient interaction

ObjectivesTo (1) evaluate the use of the pharmacists’ patient care process (PPCP) by licensed pharmacists through a simulated patient activity and (2) describe pharmacists’ awareness and perceptions of the PPCP in the state of Arizona. DesignInterviews were conducted to elicit pharmacists’ perceptions and awareness of the PPCP. A simulated patient activity involved a role-play pharmacist-patient interaction in a community pharmacy setting. The PPCP was employed as the evaluative framework to assess pharmacist behavior. Setting and participantsPharmacists licensed in the state of Arizona practicing in various pharmacy settings were recruited through e-mail list serves and snowball recruitment. Data were collected in person, by telephone, and via video chat. Outcome measuresEmergent qualitative themes from interviews were used to describe pharmacists’ awareness and perceptions of the PPCP. The presence or absence of PPCP elements were assessed during the simulations. ResultsA total of 17 pharmacists were interviewed; 16 participated in the simulated activity. Of these, 7 (41.2%) participants recalled specific details regarding the PPCP process. Participants felt that the PPCP accurately reflected their daily workflow. Accordingly, a mean of 15.8 of the 19 PPCP elements was observed in simulated pharmacist-patient interactions, still allowing room for improvement in pharmacist-led care planning. Participants indicated perceived value in a shared patient care process that facilitates collaboration with myriad health professionals and as an aid to leverage pharmacists’ role on health care teams. ConclusionIn this study, pharmacists practicing in Arizona in various settings expressed an awareness of the PPCP, felt it accurately reflected the work they do, and expressed that the tool potentially added value to their work.

The Effectiveness Of Simulation-based Learning In Preparing Exercise Physiology Students For Emerging Clinical Practice Domains

PURPOSE Given the pivotal role exercise plays in the prevention and management of chronic diseases, developing practice-ready clinical exercise physiology (EP) students to program and prescribe exercise-based interventions across these conditions is critical. In emerging clinical domains, the lack of practicum opportunities makes it challenging to provide students with the vital opportunity to translate theory into practice. This study reports on the impact a simulation-based learning experience (SBLE) had on EP student's confidence and perception of knowledge in the clinical domain of palliative care. METHODS: 12 EP students completed a palliative care interprofessional SBLE alongside students from Dietetics (n=50), Pharmacy (n=44) and Social Work (n=7). The SBLE comprised modules on what is palliative care, effective communication for grief, and spiritual and cultural considerations in palliative care. Experienced and accredited practitioners across the range of health disciplines facilitated the SBLE which included pre-reading, briefing, simulation using simulated patients, and debriefing components. Interprofessional simulated patient interactions included initial consultations, education and treatment planning, and a multidisciplinary case conference. A post-simulation questionnaire explored the effectiveness of the SBLE in developing palliative care graduate capabilities. RESULTS: 100% of students ranked their confidence in caring for people with a life-limiting illness as moderate or higher (mean 7.6/10), while 91.7% of students ranked their knowledge and preparedness as moderate or higher (mean 7.5). 75% of students reported having one or no experience, in the past twelve months, caring for a person who has died due to a life-limiting illness in either a clinical placement, employment or personal capacity. Qualitative responses supported the quantitative data with students appreciating the opportunity of being exposed to the clinical domain in a safe and supportive environment that bridged the gap between theory and a real world setting. CONCLUSIONS: The positive impact on student confidence and perceived knowledge highlights the influence of SBLE in palliative care, suggesting a broader utility for this mode of learning in other emerging clinical domains for EP students.

The role of metacognition in teaching clinical reasoning: Theory to practice

The ability to think critically in an uncertain and complex health-care environment is a paramount skill needed for health profession students to transition to clinical practice. Experts and educators in health profession education have unintentionally created confusion regarding operationalizing critical thinking, clinical reasoning, and clinical decision-making. In the purest form, health profession educators are referencing the cognitive abilities of a clinician to transfer thinking skills from an academic to a clinical setting. The problem with teaching clinical reasoning in health professions is that the ability to transfer knowledge and skill to patient care is often inefficient. Metacognitive awareness provides a theoretical and practical construct to make previously unconscious cognitive processes overt. The benefit of integrating and scaffolding pedagogical practices to emphasize explicit student knowledge and regulation of cognition may benefit health profession educators in teaching future clinicians how to handle cognitively complex problems. Making clinical reasoning overt through metacognitive awareness provides health profession educators a framework which helps to teach and assess cognitive strategies associated with clinical reasoning. Metacognitive awareness operationalizes a complex construct to allow a definitive way for health profession educators to instruct the cognitive system, resulting in enhanced clinical reasoning. Learning the components of metacognitive awareness is essential to a solid foundation for students and faculty. As students receive further instruction and feedback on cognitive strategies, the potential exists to improve metacognitive judgments. Case-based learning, simulated and standardized patient interactions, and experiential learning all provide pedagogical tools to promote metacognitive awareness in health profession students. Through serial assessment of metacognitive awareness, health profession educators may also gain valuable insight into how students develop cognitive strategies for future clinical reasoning. The increased ability to plan and evaluate cognitive processes may aid health profession students and educators in attaining more meaningful thinking for complex problem-solving in clinical practice.

A program to train medical physicists for direct patient care responsibilities.

ObjectivesTo develop a training program designed to meet the specific needs of medical physicists as they transition into a clinical role with direct patient care responsibilities.Materials and MethodsThe training program was designed in collaboration with the faculty at the UC San Diego School of Medicine and incorporates training techniques that have been shown to be effective in improving communication skills. The program emphasizes experiential, practice‐based learning over didactic presentations.ResultsThe training program is comprised of 5 components: 1) a 1‐day Clinician‐Patient Communication Workshop run by the UC San Diego School of Medicine, 2) Communication Strategies for Radiation Oncology, which consists of two, 2‐hour sessions designed to provide trainees with patient communication skills that are specific to patient interactions in radiation oncology, 3) Simulated Patient Interactions, in which trainees perform mock physicist‐patient consults with trained patient actors, 4) Faculty‐Observed Patient Consults, and 5) a Case‐Based Treatment Toxicity Course. A competency assessment mechanism was also developed to provide a clear set of objectives and to guide trainer feedback. [Correction added after first online publication on November 7, 2018: The phrase ", which consists of two, 2‐hour" was added above.]ConclusionsThe training program that we have developed incorporates an array of established education techniques and provides a comprehensive, accessible, means of improving medical physicists’ patient communication skills.

Development and evaluation of an elective course that incorporates a standard medication therapy management certificate program

Background and purposeTo describe the development and evaluation of a medication therapy management (MTM) elective that incorporates a nationally recognized certificate training program (CTP) by assessing changes in perceived abilities and values among student pharmacists, knowledge of course material, and performance conducting MTM services. Student satisfaction with course content and delivery model was also evaluated. Educational activity and settingUniversity faculty developed a didactic elective course to provide third-professional year student pharmacists with the opportunity to meet the learning objectives of the American Pharmacists Association (APhA) “Delivering Medication Therapy Management Services” CTP. Additional learning activities developed by course faculty included supplemental didactic content, reinforcement exercises, simulated patient interactions, self-reflections, and detailed faculty assessment and feedback. Pre- and post-course surveys collected information about student perceptions and values. Course grades for quizzes, midterm, follow-up, and final comprehensive medication review (CMR) assessments were retrospectively analyzed to assess student performance. Student satisfaction with course content and delivery methods was assessed via a survey. Findings and discussionStudent-reported perceived abilities improved across all survey items and there was high baseline agreement with MTM value statements. Quiz results suggested student achievement of course objectives. Student performance improved in most grading domains from the midterm to final assessment. A majority of students were satisfied with the course content and delivery methods. SummaryEvaluation of student perceived abilities and values, performance, and satisfaction support the successful incorporation of the MTM CTP along with faculty-developed supplemental content and activities into a longitudinal elective course in the pharmacy curriculum.

Impact of Standardized Simulated Patients on First-Year Pharmacy Students’ Knowledge Retention of Insulin Injection Technique and Counseling Skills

Objective. To compare pre- and post-intervention test scores assessing insulin injection technique and counseling skills among P1 students with (intervention) or without (control) simulated patients, and to compare counseling checklist and knowledge retention test scores between groups. Methods. This study utilized cluster randomization. In addition to traditional instruction, the intervention group counseled a simulated patient on the use of insulin using the teach-back method. Test score changes from baseline were analyzed via two-sample t-test. Results. The intervention group exhibited a significantly greater increase in knowledge test scores from baseline compared to the control group. Similar changes were seen in post-instruction counseling checklist scores and knowledge retention test scores from baseline. Conclusion. Simulated patient interactions, when added to traditional coursework within a P1 skills lab, improve student counseling aptitude and knowledge retention scores.

Building skills, knowledge and confidence in eating and exercise behavior change: Brief motivational interviewing training for healthcare providers

ObjectiveObesity related health problems affect individuals, families, communities and the broader health care system, however few healthcare providers (e.g., doctors, nurses, social workers, psychologists, counselors) receive formal training in obesity prevention interventions. We examined the effectiveness of training healthcare providers in brief motivational interviewing (brief MI) targeting eating and exercise behavior change. Methods163 healthcare providers participated. 128 participants completed a one-day experiential brief MI training workshop followed by electronic peer-support and a further 35 matched controls did not receive the training. ResultsParticipant's knowledge of brief MI and confidence in their ability to counsel patients using brief MI significantly improved following training (p<0.05) and remained at 3 and 6-month follow-up (p<0.05). Brief MI skills assessed during the simulated patient interactions indicated a significant improvement across two practical training blocks (p<0.05). ConclusionHealthcare providers can learn brief MI skills and knowledge quickly and confidence in their counseling abilities improves and is sustained. Practice implicationsHealthcare providers may consider brief MI as an obesity prevention intervention.

Training obstetrics and gynecology residents to be effective communicators in the era of the 80-hour workweek: a pilot study.

BackgroundTo ensure optimal patient care, physicians must establish effective patient-physician relationships and thoughtfully incorporate their patients’ perspectives into their counseling. Historically, these skills are acquired with increasing clinical experience. However, given increasing work-hour restrictions, OB/GYN residents have fewer opportunities to develop these skills. Therefore, the objective of this study was to determine if an interactive learning method is an effective tool by which to teach OB/GYN residents how to communicate with complicated patients.MethodsAn experiential simulation model was developed to teach OB/GYN residents effective communication skills for dealing with patients experiencing a pregnancy-related complication. A simulated patient interaction was designed for first-year residents. Specific scenarios were constructed based on challenging clinical scenarios identified by second-year residents. Non-judgmental communication, culture competency awareness and reflective listening were key skills that were taught as part of the clinical scenarios. Both acceptability and utility of the exercise with the first-years was assessed by a follow-up survey.ResultsSeven first-year residents participated in the education session consisting of four physician-patient interactions with specific learning objectives for each. These first-year residents all indicated that they would employ the skills practiced during the intervention into their future practice of medicine, and that their comfort level in caring for complex obstetric patients had increased. Moreover, all first-year residents endorsed that this educational strategy was potentially applicable to other aspects of their training.ConclusionsSimulated patient exercises can be utilized in multiple arenas to teach OB/GYN residents communication skills, while simultaneously addressing their clinical knowledge deficits. Early implementation of such a curriculum in an OB/GYN residency will lay the foundation for the development of empathetic and culturally competent physicians.

Simulated Patients in Audiology Education: Student Reports

Despite increased attention in recent years to audiology counseling education, students remain concerned about their abilities to interact with patients in challenging situations, such as when breaking difficult news. Simulated patients, or actors trained to portray patients in clinical scenarios, have been used for many years in medical schools to teach and assess students' interpersonal skills, and are just beginning to be used in audiology programs. Although research suggests that medical students value simulated patient experiences, little is known about whether the same is true for audiology students. The purpose of this study was to survey audiology students who had completed a simulated patient counseling experience as part of their graduate coursework at Central Michigan University, to learn about their experiences and views of this instructional format. This study used descriptive and comparative statistics to report student observations and to determine if student responses to evaluative questions differed from chance. Study participants included 29 audiology students who had completed a "breaking difficult news" simulated patient experience as part of their required graduate coursework in patient counseling. Participants completed an online survey that included seven evaluative five-point Likert-scale questions about their simulated patient counseling experience. Participants also completed one multiple-choice question on suggestions for future simulated-patient sessions. For each of the seven evaluative questions, a majority of participants (76-100%) responded positively, agreeing or strongly agreeing that the experience was helpful to their learning. For each of these evaluative questions, a χ² analysis revealed that the distribution of positive (i.e., strongly agree and agree) to nonpositive (i.e., neutral, disagree, and strongly disagree) responses differed significantly from chance (p < .0001, df = 1). The results also indicated that when asked which of several suggested clinical scenarios would be helpful for future sessions, simulations of challenging patient types (i.e., hostile, rambling, and noncommunicative patients) were supported by most (62-90%) respondents. The results of the present study are consistent with findings of medical students' positive perceptions of simulated patient experiences as well as those previously reported for audiology students. Together, these data support the continued use of simulated patients as a method of instruction for audiology counseling education for breaking difficult news, and suggest a potential value of using simulated patient interactions for training counseling skills in other clinical situations and scenarios.

Minding the gap between communication skills simulation and authentic experience

Concurrent exposure to simulated and authentic experiences during undergraduate medical education is increasing. The impact of gaps or differences between contemporaneous experiences has not been adequately considered. We address two questions. How do new undergraduate medical students understand contemporaneous interactions with simulated and authentic patients? How and why do student perceptions of differences between simulated and authentic patient interactions shape their learning? We conducted an interpretative thematic secondary analysis of research data comprising individual interviews (n = 23), focus groups (three groups, n = 16), and discussion groups (four groups, n = 26) with participants drawn from two different year cohorts of Year 1 medical students. These methods generated data from 48 different participants, of whom 17 provided longitudinal data. In addition, data from routinely collected written evaluations of three whole Year 1 cohorts (response rates ≥ 88%, n = 378) were incorporated into our secondary analysis dataset. The primary studies and our secondary analysis were conducted in a single UK medical school with an integrated curriculum. Our analysis identified that students generate knowledge and meaning from their simulated and authentic experiences relative to each other and that the resultant learning differs in quality according to meaning created by comparing and contrasting contemporaneous experiences. Three themes were identified that clarify how and why the contrasting of differences is an important process for learning outcomes. These are preparedness, responsibility for safety, and perceptions of a gap between theory and practice. We propose a conceptual framework generated by reframing common metaphors that refer to the concept of the gap to develop educational strategies that might maximise useful learning from perceived differences. Educators need to 'mind' gaps in collaboration with students if synergistic learning is to be constructed from contemporaneous exposure to simulated and authentic patient interactions. The strategies need to be tested in practice by teachers and learners for utility. Further research is needed to understand gaps in other contexts.